§ 9789.12.11 Evaluation and Management: Coding - New Patient; Documentation

Summary

A guide to billing for evaluation and management (E/M) services for new patients, complete with links to the necessary regulatory information and detailed instructions

In section 9789.12.11, the California Division of Workers’ Compensation (DWC) separately defines and distinguishes:

  • new patients, and
  • established patients.

New Vs. Established Patient

  1. A “new patient” is one who is new to the physician or medical group or an established patient with a new industrial injury or illness. Only one new patient visit is reimbursable  when billing for the same incident, injury or illness.
  2. An “established patient” is a patient who has been seen previously for the same incident, injury or illness.

Section 9789.12.11 also establishes the required guidelines for Evaluation & Management Services. For Evaluation & Management services, physicians and qualified non-physician practitioners must use either:

  • the “1995 Documentation Guidelines for Evaluation & Management Services,”
  • or “1997 Documentation Guidelines for Evaluation and Management Services.”

California Code of Regulations (CCR)

§ 9789.12.11 Evaluation and Management: Coding - New Patient; Documentation

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Resources

Technology is your friend when it comes to calculating correct fee schedule reimbursements. DaisyBill’s OMFS Calculator makes determining accurate reimbursements quick and hassle-free for current AND past dates of service.

Sign up for a free trial of the DaisyBill OMFS Calculator and instantly start billing easier.

Try the DaisyBill OMFS Calculator

Was this article helpful?

About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

Read more

Search results for: